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0AT43ep, 22. 2015 2: 13PM SAN .IOAQUIN COUNTY �,w No 1911 EI?- 4014UMBER <br /> � � � � <br /> " ' ' ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> OCT 14 2015 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . Telephone: (209)468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br /> Ei°VRONMENTALHE.AI.TH PUBLIC RECORDS RELEASE APPLICATION <br /> ccrztn(`F� <br /> APPLICANT: FO(gh. M_Falun lS BUSINESS/AGENCY: J J COu.rrflill PI Ljo(t _ wUI F_ <br /> ADDRESS: 810 :R• ijaFt lDn Ave • CITYISTATE/ZIP: 90(Ik/1a C`� �S2C7� <br /> PHONE(1): �ZO�` y�oK' 9Jt7�S PHONE(2): FACSIMILE: tbi { <br /> Please allow 10 buslness days from date of application submittal for the records to be available. <br /> Staff will contact you to arrange an appointment date and time to review the requested records. <br /> ❑ CHECK BOX TO EXPEDITE REQUEST fTf-�130 F�E((�ASH OR CHECK ONLY)-REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT '_ nStT �-(^C/ DATE G(^LI-IS- <br /> Electronic Information: ❑ List❑ Map—Description: <br /> FILE ADDRESS <br /> EHD USE ONLY <br /> Street# Street Name City <br /> N. m wa(lA c)(iJe, ��� / <br /> 2. L'2 Unit 1 <br /> 3. E3 Uni!2 <br /> 4, Ly/unit 2H ( <br /> r7. <br /> $. Q16nit 3 <br /> 041R4 <br /> 6. SITE MITIGATION <br /> 9. <br /> 10. 6Y(init 5 <br /> Spector Date Range of Information Requested: From to <br /> ENVIRONMENTAL HEALTH DEPARTMENT FILES �r <br /> ®"UNDERGROUND TANK(UST)CLEANUP SITE(LOP) 'S MEDICAL WASTE FACILITY L SOLID WASTE FACILITYNEHICLE <br /> ®OTHER CLEANUP SITE(NON-LOP) ®HOUSING ABATEMENT WASTE TIRE <br /> UNDERGROUND TANK(MONITORING/REMOVAL) ❑FOOD FACILITY ,@ DAIRY <br /> JN ABOVEGROUND TANK 'CHICKEN RANCH/DOG KENNEL [Y WASTEWATER TREATMENT PLANT <br /> IRHAZARDOUS WASTEIHAZARDOUS MATERIALS ❑MOTEL/HOTEL .PUMPER TRUCK/YARDICHEMICAL TOILETS <br /> TIERED PERWITED FACILITY ®POOUSPA LAND USE APPLICATION SITES <br /> ❑TATTOOIBODY PIERCING WCOMPLAINT/RESPONSE RECORDS ❑OTHER(PLEASE SPECIFY) <br /> WELL AND SEPTIC PERMIT RECORDS ARE AVAILABLE FOR REVIEW: MONDAY-FRIDAY 6:00 AM-5:OOPM(EXCLUDING HOLIDAYS) <br /> 1, List un to ten addresses in the space above. Select the type(s) of files from the list above by checking the appropriate <br /> box(es). At least one file type MUST be selected. Fax to(209)464-0136 or mail to the address Indicated above. Address <br /> ranges will not be accepted.Applications received after 3:00 pm will be processed the next business day. <br /> 2. For assistance in identifying the nature and content of EHD records,please contact EHD at the number noted above. <br /> 3. The EHD will notify the applicant if any EHD files exist. An appointment for review will be confirmed approximately ten (10) <br /> days after receipt of application. The files will be held for a maximum of five business days for review. Appointments <br /> should be scheduled accordingly. <br /> 4. Any file not returned In the same condition as released will be reorganized by EHD staff at the expense of the applicant. <br /> Future file reviews by the same applicant may require a$130 deposit prior to review. `*`BOXED AREA-EHD USE ONLY-- <br /> n u......�.4. —rr...A+ aft- calfs nnm n0�-'r ` Staff Name: <br /> Received Time=Sep. 22. _2015= 2: 09PN1_No. 9621 <br /> END 4046 711115 <br />